[Value of Doppler blood flow velocity measurements in peripheral percutaneous laser-assisted angioplasties].
OBJECTIVE
The aim of the study was to establish the prognostic value and clinical implications of blood flow velocity measurements by Doppler guide wires during peripheral laser-assisted percutaneous transluminal angioplasty (PTLA).


METHODS
39 patients presenting with symptomatic peripheral arterial obstructive disease underwent angiography and blood flow velocity assessment by Doppler guide wire (0.018") prior to and following PTLA. Both quantitative angiography (QCA) for measurement of luminal diameters and Doppler assessment of maximum peak velocities (MPV) were performed 2 cm proximal, over and 2 cm distal to stenoses. The results were compared with the following clinical endpoints: 1. Short-term clinical improvement by AHA-criteria during first follow-up examination and 2. criteria for patency suggested by Rutherford [12] within 1 year (1-22 months).


RESULTS
Angiography demonstrated initial success of PTLA in all patients. Relative diameter stenosis decreased from 70 +/- 0.04% to 17 +/- 0.05%. Mean clinically category improved from 2.7 +/- 0.1 to 1.2 +/- 0.1 following intervention. Mean grade of clinical improvement was 2.8 +/- 0.1. 22/39 patients demonstrated event-free follow-up examinations. Doppler measurements of MPV post PTLA in the proximal reference segment correlated with clinical outcome. MPV > or = 90 cm/s was associated with good primary success, unlimited walking capacity and event-free follow-up. MPV > or = 70 cm/s predicted an improvement of short-term clinical outcome by 2 grades (predictive value 80%). MPV < 70 cm/s was associated with both minor primary clinical improvement (+/- 0, +1) and increased incidence of restenosis during follow-up.


CONCLUSIONS
Following PTLA, MPV adds information to angiographic success. MPV > or = 90 cm/s in a proximal reference segment following PTLA predicts good clinical outcome, whereas MPV < 70 cm/s is associated with minor primary clinical success and increased rates of restenosis.
Wellnhofer
E
E
Innere Medizin-Schwerpunkt Kardiologie/Angiologie, Virchow Klinikum und Deutsches Herzzentrum, Humboldt Universität Berlin.
Biamino
G
G
Bernard
L
L
Ragg
C
C
Fleck
E
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D017222:Angioplasty, Balloon, Laser-Assisted; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001783:Blood Flow Velocity; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D013997:Time Factors
Stellenwert von Doppler-Blutflussgeschwindigkeitsmessungen bei peripheren perkutanen laserassistierten Angioplastien.